OSCE

Anaesthesia Posting

Batch 5

Yr 4 : CG 28, 29 & 30

Friday, 2 September 2005

Question 1

1. How would you make a

clinical assessment of the

severity of this attack?

You are called to the accident and emergency department to see a 31-year-old lady, known to have asthma, who has been admitted with acute shortness of breath.

Question 1

2. What investigations might be

helpful?

(Name THREE, state how it might be

helpful)

You are called to the accident and emergency department to see a 31-year-old lady, known to have asthma, who has been admitted with acute shortness of breath.

Question 2

1. Nitrous oxide is

contraindicated in patients

with pneumothorax,

pneumopericardium or intestinal

obstruction because it

_______________________.

2. Thiopentone is short acting

because _______________.

Question 2

3. Suxamethonium should be

used with caution in patients

with renal failure because

_______________________.

4. Name TWO likely

complications of the use of

epidural morphine for postop

analgesia.

Question 2

5. Propofol causes

cardiovascular depression by

______________.

Question 3

1. State two uses of the part labeled A

2. What is the use of the Murphy’s eye (B) ?

3. Where should the tip of the tube (C) lie in the tracheal?

A

B

C

Question 3

4. Name two methods of confirming

a trachea intubation

5. State 4 complications of trachea

intubation

Question 4

1. Name TWO methods of pain relief

appropriate for this patient apart from

intra-muscular analgesics.

2. Give THREE medical reasons for

providing good post-operative pain

relief?

60 year old man had upper abdominal incision for total gastrectomy.

Question 4

3. Different patient require different amount of

intramuscular morphine for similar operation.

Give TWO reasons why this happens?

4. Write a postoperative order for analgesia for

this patient?

5. State TWO complications of this choice of

analgesia.

Question 5

1. List THREE basic requirements

of oxygen therapy systems.

2. What is device A

A

Question 5

2. What is device B 3. What is device C

BC

Question 5

3. Name THREE complications of

oxygen therapy.

Question 6

1. List 3 reasons for conducting a

preoperative visit.

A 60 year old patient is scheduled for a cystocopy under anaesthesia. He gives ahistory of hypertension. He also had a previous general anaesthesia for haemorrhoidectomy. On examination, his BP was 130/80 mmHg.

Question 6

2. What is his ASA status?

3. List 2 useful anaesthesia related

information can you drive from his

previous anaesthesia record.

Question 6

4. If the patient appear very anxious, what

can be done to help him? State 2

measures.

5. If the patient in on atenolol and

nifedipine for hypertension would you

stop the medication on the day of

surgery?

Question 7

1. Comment on his blood pressure on

admission. How would you check on this

reading.

A 51-year-old sales executive presents for extracton of his wisdom teeth. He has not seen a doctor for many years, and is not taking any medication. On admission to the ward, his blood pressure was found to be 170/110 mmHg. He weighs 80 kg.

2. His preoperative CXR

and ECG are as

shown. Comment on

the CXR and ECG.

Question 7

3. What should have been done before

this patient was anaesthetized?

4. Comment on the operative ECG.

This patient was subsequently given a standard anaesthetic. During extraction of his teeth, his BP rises to 200/115 mmHg, and his ECG is as shown:

Question 7

1. In an adult, name a suitable space in which a

spinal block can safely be performed?

2. Why is it safe to perform the spinal block at

that space?

3. The anaesthetist chose to perform the spinal

block with a rounded 27G spinal needle.

What complications was he trying to avoid

by using this needle?

Question 8

4. What are the patient risk factors for the

above complication?

Name TWO factors.

5. How does the anaesthetist know that he

has reached the subarachnoid space with

the spinal needle. Give ONE answer.

Question 8

6. After establishing that the spinal needle was in

the subarachnoid space, the anaesthetist

proceeded to inject 2.5 ml of 0.5% heavy

bupivacaine. The spinal block was established

to a level of T6.

What is the likely cardiovascular complications

that you will see? Name the most likely.

Question 8

7. How will you deal with this

complication? Name 2 answers.

8. If the block had extended to a level of

T1, what additional cardiovascular

complication are you likely to see.

Name

ONE answer.

Question 8

Question 9

1. Following intravenous thiopentone,

the following may occur

a. severe hypotension

b. respiratory depression

c. liver toxicity

d. increased intracranial

pressure

e. epileptic convulsions

Question 9

2. Which of the following results should

lead to postponement of a routine

operation and further investigation

a. haemoglobin 10.8 g/dl

b. glycosuria

c. serum potassium 5.0 mmol/l

d. serum sodium 135 mmol/l

e. platelets of 60,000/mm3

Question 93. The following are true in regard of arterial blood gases:

a. the normal pH is 7.0

b. the normal standard bicarbonate

is 32 mmol/l

c. a PO2 of 75 mmHg is normal for an

80-year-old man

d. the PCO2 is raised in hypothermia

e. the base deficit is the number of

mmol of bicarbonate per litre of blood

required to correct the pH to normal, at a PCO2

of 40 mmHg and temperature of 37°C

Question 9

4. On the ECG, P-waves are always

seen in

a. atrial flutter

b. ventricular tachycardia

c. nodal rhythm

d. complete heart block

e. supraventricular

tachycardia

5. Intubation of the right main bronchus

with unchanged ventilation may lead to:

a. hypotension

b. hypercapnia

c. increased requirement for

anaesthetic agent

d. collapse of the right upper

lobe

e. hypoxaemia

Question 9

Question 9

6. Depolarizing block may be produced

by:

a. suxamethionium

b. rocuronium

c. atracurium

d. atropine

e. isoflurane

Question 9

7. A patient 4 hours postoperatively shows the

following:- BP 170/100 mmHg, pulse 100/min, warm

periphery, arterial blood gases on air PCO2 70

mmHg, PO2 70 mmHg, bicarbonate 28 mmol/l.

This may be due to:

  a. segmental pulmonary collapse

b. septicaemia

c. overtransfusion

d. underventilation

e. metabolic acidosis

Question 98. Morphine

a. may cause histamine release

b. is a partial agonist at the μ-

receptor

c. causes miosis

d. causes vomiting by direct

stimulation of the

chemoreceptor trigger zone

e. arterial PCO2 is markedly

raised with normal therapeutic

doses

Question 99. Inaccuracies in the measurement of

central venous pressure (CVP) may arise

from:

a. a change in the position of

the patient

b. misplacement of the

catheter

c. straining during respiration

d. arterial hypotension

e. hypoxaemia

Question 9

10. Cardiac output is increased by:

a. a rise in venous filling

pressure

b. a rise in body temperature

c. an increased metabolic rate

d. standing up from the lying

position

e. pregnancy in the last

trimester

T H E E N D

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